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This article develops the idea that many inflammatory, auto-immune or auto-aggressive diseases might result from conditioned responses acquired when occasional, possibly minor pathological conditions, normal organ fatigue, or similar sensations, are reinforced by an intense neural reward coinciding, often by pure bad luck, with these minor troubles.

After such conditioning, and especially in times of frustration or distress, the brain will repeatedly try to obtain the reward again by recreating, with an intensity in proportion to the degree of frustration, the sensorial pattern of the initial minor trouble, producing auto-aggressive effects. This leads naturally to the idea of trying to extinguish diseases implying self-aggression by applying negative reinforcement. This behavioural strategy has been tested for some minor or medium-severity inflammatory/auto-immune troubles and, essentially, it works, although it implies practical difficulties that are reviewed in the text. Furthermore, the experience was very limited because of the difficulty of convincing people to try for good a scarcely tested technique requiring intense mental effort and completely different from the medical treatments people are used to. The article describes the physiological-behavioural model underlying our proposal, evaluates different possibilities of treatment, and provides useful practical advice. In particular, it appears that our proposal seems best suited for diseases in which the mental abilities of the person are intact and the inflammatory aggression is clearly identifiable by its symptoms, for example pain, itching, fatigue or paralysis. Possible candidate diseases could be, for example, superficial allergies or irritations, digestive inflammatory problems, rheumatoid or circulatory troubles, or motor neurological diseases like multiple sclerosis, Guillain-Barre syndrome and possibly ALS or Parkinson.

The article is completed by some guidelines on the prevention of diseases implying auto-aggression, based on self-control, diet, exercise, mutual help, and avoidance of psychoactive or aggressive agents.

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Interesting and I can see where the researcher is coming from and would agree that modifying behaviours may have some affect on outcomes, at least, in early MS.

As to it being the cause-much more research would be needed, but if it is suggesting that a relatively harmless pathogen can be exacerbated through psycho-neuro-immunological interactions and trigger a cascade of immune and endocrine responses it is not so far fetched as it may first sound.

I do follow psycho-neuro-immunology (PNI), which is what he is essentially talking about, closely and I am convinced it plays a role in most auto-immune (no, I am not saying MS is an autoimmune condition per se only that without doubt the immune system plays a major role) and inflammatory mediated conditions. As a CBT practitioner I see how distress, stress, pain, fear, depression all alter the brain, making profound biochemical changes, some short lived, some permanent.

About 30 years ago, in the earlier stages of my mum's MS, there was a hypothesis that sustained, extreme and prolonged stress or anxiety was a contributing factor in the development of MS. I was pretty young and naive, and my limited understanding at the time made me think, "Oh... it must mean you're so unhappy, for so long, your body starts eating itself". The theory at that time must have been more sophisticated than that, but this new idea seems to be a step forward along the same lines.

I'm glad that some people are exploring different avenues about this disease, but I would just be a bit worried about tabloid over-simplification and public perception of the theory -- I can just imagine unscrupulous people selling books entitled, "you can think yourself out of MS", and some people thinking, "it's your fault for not being positive enough", which wouldn't do any of us any good.

modifying behaviours may have some affect on outcomes

Manchester, could you explain a bit more about this? I'd like to understand more fully what you mean, by the way, is CBT cognitive behavioural therapy?

Yep, I can completely agree with you as to the tabloid type headlines and of course, at some point, somewhere it will be interpreted as 'MS- it's all their heads' which is not what PNI is about, it is a much more complicated interaction.

Yes, CBT is cognitive behavioural therapy. Where it fits in to PNI is in that it has a focus on the stress response and modifying this.

Though not by any means, and I must stress this, with the intention or primary outcome (except in some clinical trials to measure this specifically) to, for example, lower pro-inflammatory cytokines, however, it may and does seem at this stage in research to have this affect.

Outside the growing but still narrow area of PNI and the use of CBT in this it is used mainly to help mental disorders - depression, panic and anxiety type disorders.

Rather than explore, or I shoud say, focus heavily on the 'why' of someone having these disorders (and years of costly therapy), CBT focusses on modifying behaviour, basically breaking someone's negative emotional cycle with positive reinforcement, coping mechanisms, rational and realistic belief (including sometimes recognising healthy negative beliefs from illogical) and displacement techniques etc. I specialise in treating individuals with Obsessive Compulsive and anxiety disorders.

That's a very simplistic explanation but I do believe that it may be found it can play a positive role for people with MS.

I hate to make to big a thing of it but suffice to say I have used these techniques for a very long time myself.

Indeed this study doesn't seem very scientific.
I know quite a lot of people who are even more stressed or have had more serious issues like being raped or being asylum keeper(and so on), but they do not have any MS.
The worse of that kind of analysis, is that it made the weakest of us wonder then: what have i done, was my mum nice enough with me, did the society made me sick?
On the other hand i can't deny that when i'm facing a stressful situation, I have more relapses, but this is not a rocket like discovery.

This is a hypothesis not a study so don't expect to see clinical trial type data, so in those terms it is not meant to be 'very scientific'.

PNI research is in it infancy, it does attrack the odd bonkers looking hypothesis but IMO it is important that theories can be put out there to debate and discuss, however, uncomfortable they may seem or what buttons they may trigger in us.

As Dom said it is a)good that researchers are exploring other avenues and b)there is a worry that this could be simplified or misinterpreted to mean it is saying postive thinking is all you need to do or indeed that stress causes MS. Which is not what this hypothesis appears to be saying to me; only that these factors alter the biochemistry of the brain and this in turn may exacerbate MS.

I don' think anyone at this stage can say stress doesn't play a part and by this I mean long term chronic stress or indeed enivronmental or underlying clinical depression or range of other factors that underline the interplay between the immune system, the endocrine system and the psychological dynamic.

In the last two decades medicine is breaking from the concept of 'mind' and 'body' are separate and recognising the interelationship. Nor should it make any one uncomfortable, though it is understandable why it does and why people, with various conditons, are resistant to contemplating this. In MS ,maybe, because it is so often, for many people with MS, that they endured 'well intentioned' family and friends or even not so well intentioned telling them it is all in the mind. This is crap psycho-babble and nothing to do with PNI or what PNI is about.

Chronic stress plays a role in many conditions so why not MS? What makes MS so exclusive that stress or any negative thought pattern does not play a role? Maybe it plays a role for some people and not for others? Maybe it is more applicable to some types of MS and not to others. Who knows and that is what a hypotheses is about-exploring.

Unfortunately the self help business takes things to extremes and does over- simplify what is a very complex and biochemical process and interelationship. It still can help a lot of individuals so I am not knocking it but PNI is not self help in the literal sense promoted by self-help but a recognise bona-fide branch of medicine and science

Here are few studies of PNI and the interelationship to disease that may illustrate

I am becoming more and more convinced that MS is a multifactorial syndrome: in other words, there is an extremely complex and varied chain of events which can include many of the options discussed on this website -- including hormones, stress, genetic susceptibility, bacterial or viral infection, vitamin or mineral deficiency, a lack of intestinal parasites, leaky gut or digestive disorder -- in the end some, all, or just one of these things may be implicated, but it will vary from person to person. For instance , we've all had stomach ache, but that doesn't prove it was all caused by the same thing.
Increasingly, researchers investigate and report on things which have an effect on a "subset" of MS patients, which is another way of saying that not everybody with MS has the an identical disease process, even though the end result is the same.

I bet a lot of us have experienced well-meaning, thoughtless or ignorant people telling us to "keep positive". I've had friends with other illnesses like cancer who have found this intensely cruel... you can easily take it to mean, "if you get worse, you didn't try hard enough", or, "I'll still come and see you, so long as you don't show me you're upset". Personally, I'm able to just ignore it -- I know my true friends would never say such things,

Dom,
I was going to jump in and wholeheartedly agree but I've heard you can't swim and I don't want to compound things if the problem does involve a leaky catheter!

Interesting that you mention the parasites again. The Feb 2007 (Volume 61, Issue 2, Pages 85-184 February 2007)Annals of Neurology just came out with that Argentinga Correales/Farez--parasite vs MS study.

In the same issue neurologist John O Fleming of U of Wisconsin (has the money from the NMSS to do a T suis/MS clinical trial but the FDA is holding things up) did a very interesting/informative editorial regarding that study and the field in general.

BOTH the article on the study and the editorial are very well written and thought provoking. I'm convinced that in the future we're going to be hearing a lot more about this subject.

I firmly believe that stress over a prolonged period of time has a significant impact on anyone's body. However if that a person has a predisposition for MS due to any number of reasons such as genetic, environmental; list goes on, a significant amount stress will have a detrimental affect and can lead to a MS. I believe this because I think that my MS is a result of breaking my hip when I was 13 and a genetic disposition for this illness and then a very stressful 2 years when I was 16 and septicaemia after an operation when I was 17! I think my body just gave up!

I also think it's very easy to make a generalisation, it's important to remember that not everybody who has the stress will go on to develop MS, there are so many factors involved and are of varying importance.

Manchester: I thought MS was an auto immune disorder or condition? Am I wrong in thinking that?

Kt wrote:Manchester: I thought MS was an auto immune disorder or condition? Am I wrong in thinking that?

In one sense you can say any disease that has an inflammatory mediated course is auto-immune until proven otherwise.

Unfortunately, there is no unified concept of what is MS and what has been recognised and concentrated on by researches is the only unifying factor to date- that it involes the immune system and is mediated by the immune system.

For a long time, as we all know, MS was simply stated as an auto-immune disease, however, for the last 8 years or so (by my reckoning in following research) a neuro-degenerative model has slowly been posited. This is not instead of but rather part of.

It is very much what came first the chicken or the egg? Or as with most things in life it is not quite so clear cut.

MS has, without doubt, (as I understand it) has an inflammatory component (auto-immune driven)which causes damage but also now recognised a degenerative component which also causes damage.

The latter component is not soley driven by inflammation but is found very early in MS and while there is a complicated interplay between the inflammatory immune driven component and neurodegeneration which is not yet fully understood, recent studies have show that, for example, grey matter atrophy may occur separately to inflammatory demylenation or even before any inflammatory response kicks in (ie before you have the slightest inkling you have MS).

You will now see more and more studies that describe MS is an chronic inflammatory disease of the nervous system with a presumed autoimmune origin. Not so categorical as it used to be stated.

Just to complicate it further it may be, if MS is more a syndrome and some findings are pointing this way, then for some people it will be firstly be an autoimmune condition and for others firstly a neuro-degenerative condition with a secondary inflammatory response/reaction. This all suggests distinctly different pathogenesis.

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